Surgical treatment of sciatica issues

The surgical treatment will be proposed to patients with prolonged medical treatment (over 6 weeks) proved a failure or first-line, in an emergency, in case of situations at risk of irreversible neurological injury.

These risk situations leading to surgical treatment in urgency are:

• The presence of motor neurological deficit (paralysis), this is called sciatica paralyzing.
• The presence of sphincter disorders (the cauda equina syndrome), loss of urine or stool, recent persistent constipation, impotence, urinary retention with pushing force ...
• Sciatica hyperalgic with inability to stand, walk, or not only relieved by morphine treatment.

Microsurgical treatment of lumbar disc herniation consists in the ablation of the herniated disc and minima cleaning of disk to avoid early mobilization of another free disc fragment (early relapse), releasing the nerve root and you thereby relieving sciatica. This aim is achieved in 85% of cases.

• It remains 15% of unsatisfactory patient outcomes: nerve damaged by the prolonged compression (radiculopathy), the existence of lumbar pathologies associated (spinal stenosis, herniated discs on several levels, ...).

• The surgery can not repair the disk (the disk lesions are irreversible) and, back pain is relieved partially, or not at all by the intervention.

• Surgery helps partial recovery at overall sphincter dysfunction and motor or sensory neurological deficits, varies depending on the length of evolution of the deficits and intrinsic achievement of the nerve root. This recovery is all the more important that intervention is near the appearance of neurological disorder, and more random, if the duration of deficit is prolonged  (a few days are enough to seriously damaging a nerve root).

Several surgical techniques may be used in this type of intervention. The selection varies according to your age, your background, the type of disc herniation (ductal, foraminal or extra foraminal), associated pathologies (arthrosis, spinal deformity) and practicing surgeon. By cons, these techniques require a short hospital stay in the clinic.